Information Collection

Certification of Termination of Service and Relinquishment of Rights

IC 33819 under ICR 202012-3220-002 · OMB 3220-0016.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3220-0016 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form G-88 (04-17) Certification of Termination of Service and Relinquishment of Rights	Form
G-88 (04-17) Certification of Termination of Service and Relinquishme Form G-88 (04-17).pdf	Form
G-88 (04-17) Certification of Termination of Service and Relinquishme Form G-88 (04-17).pdf	Form
Form AA-1 (01-18).pdf Application for Employee Annuity	IC Document
Form AA-1 (01-18).pdf Application for Employee Annuity	IC Document
Form AA-3 (07-17).pdf Application for Spouse/Divorced Spouse Annuity	IC Document
Form AA-3 (07-17).pdf Application for Spouse/Divorced Spouse Annuity	IC Document

IC Title:

Certification of Termination of Service and Relinquishment of Rights

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 216.24

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	G-88 (04-17)	Certification of Termination of Service and Relinquishment of Rights	Form G-88 (04-17).pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: RRB-22, Railroad Retirement, Survivor, and Pensioner Benefit System

FR Citation: 79 FR 58874

Number of Respondents: 3,600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	360	360
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Application for Employee Annuity	Form AA-1 (01-18).pdf	12/09/2020
Application for Spouse/Divorced Spouse Annuity	Form AA-3 (07-17).pdf	12/09/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.